S4602 Eosinophilic Gastroenteritis With Ascites: A Rare Case Presentation and Review of Literature

Introduction: Eosinophilic gastroenteritis (EGE) is a rare disease marked by eosinophilic infiltration of the bowel wall, gastrointestinal symptoms, and exclusion of other causes of eosinophilia. Eosinophilic ascites (EA) is a rare presentation caused by edema and inflammation of the small bowel wall’s serosal layer. We present a case of a 42-year-old man with abdominal pain and ascites found to have EA. Case Description/Methods: A 42-year-old man with asthma and atopy, recently returned from Guatemala, presented with generalized abdominal pain and distention for 2 weeks. History was otherwise negative. Labs showed leukocytosis (11,490/mm³) with 21% eosinophils and elevated alanine transaminase (46 U/ml). Computed tomography abdomen revealed gastritis, duodenitis, esophagitis, and large-volume ascites. Paracentesis showed 5,500 white cells with 92% eosinophils. Workup for eosinophilia, including Strongyloides, Churg-Strauss, Toxocara, TB, vasculitis, and HIV, was unremarkable. Endoscopy revealed diffuse gastritis with normal biopsies. Although biopsy confirmation is standard, a full-thickness biopsy was deferred due to risk. The patient was treated with prednisone, with symptom resolution over 6 weeks. Discussion: EGE is a rare, benign disorder of unknown cause marked by eosinophilic infiltration of the GI tract. About half of patients have allergy or atopy; some have immunoglobulin (Ig)E specific for food allergens. A defective barrier may allow allergens to activate eosinophils via IgA, IgG, or IgE and mast cell degranulation, leading to eosinophil recruitment. Parasitic infections (Strongyloides, Schistosomiasis, Toxocara) must be ruled out. Autoimmune diseases like eosinophilic granulomatosis with polyangiitis, lymphoma, and hypereosinophilic syndrome can present similarly. EGE is a diagnosis of exclusion. Prednisone is the mainstay of therapy⁵. EGE should be suspected in patients with unexplained ascites, with ascitic fluid eosinophilia and response to steroids indirectly confirming the diagnosis.